Factors Associated with Worsening Oxygenation in Patients with Non-severe COVID-19 Pneumonia

Abstract

Background This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia. Methods This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO 2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist. Results We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 μg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52). Conclusion Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

Risk factors of COVID-19 clinical worsening: A retrospective cohort study in COVID-19 referral hospital in west Java, Indonesia

“…Previous studies showed several factors are associated with the deterioration of the disease and the poor outcome, including older age, male, comorbidities such as obesity, hypertension, heart disease, chronic obstructive pulmonary disease, and chronic kidney disease, and also laboratory parameters such as C-Reactive Protein and NLR. 3,8,10,[20][21][22][23][24] In our study, age over 60 years old, previous history of heart disease, diabetes mellitus, respiratory rate > 23x/minute, and NLR value > 3.8 were found to be statistically significant as the factors affecting the worsening of COVID-19 in multivariate analysis. Several conditions may affect the results.…”

Cardiovascular and Renal Comorbidities Included into Neural Networks Predict the Outcome in COVID-19 Patients Admitted to an Intensive Care Unit: Three-Center, Cross-Validation, Age- and Sex-Matched Study

“…Another important issue that is often omitted in epidemiological and ML studies of COVID-19 is the close correlation of many predictors to age and sex, two inherent features of every patient. The investigations comparing the age- and sex-matched patients using ML approaches are currently limited to the deep profiling of circulating proteins (including cytokines), lipids, metabolites, and miRNA collected before or around the time of hospital admission and predicting the COVID-19 positivity [ 28 , 29 , 30 , 31 ] or disease severity [ 30 , 31 , 32 , 33 , 34 , 35 ], too small single-center studies of coagulation/fibrinolysis markers in predicting mortality [ 36 ], and to the studies of the lung computed tomography images [ 37 ] or electrocardiograms [ 38 ] to diagnose [ 37 ] or exclude [ 38 ] COVID-19. The matching of study cohorts by age and sex reduces the background behind the risk factors and clarifies the pathophysiological links between the comorbidities, organ damage, and serum biomarkers.…”

Soluble Cluster of Differentiation 25 (sCD25) as a Predictor of Mortality of COVID-19 Patients in Surabaya, Indonesia

“…The CFR among critical cases was 49% and patients with older age and comorbids are factors that can increase the mortality of COVID-19 patients 7 . The severity of the disease in COVID-19 patients generally occurs 1 week after the appearance of symptoms 8,9 .…”